Job Application

Personal Information

Current Address

 Start Date at this Address


Are you legally eligible for employment in the United States of America? *
Are you 18 years of age or older? *
If you are under 18, can you provide required proof of your eligibility to work? *
Are you a citizen of the United States of America? *
If you are not a citizen, does your immigration status permit you to work? (Proof of citizenship or immigration status will be required upon employment) *
Were you previously employed by a Community Service Provider? *
Type of employment desired? (Check all that apply) *
Availability (Check All That Apply) *
Are you willing to travel if your job requires it? *
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Additional Questions

If hired, do you have the means of transportation to get to and from work? *
Have you ever been convicted of a felony, or for child abuse or sex-related crimes? *
Are you listed on the State Registry as having been convicted of abuse, neglect or exploitation? *
Have you been convicted of a moving violation in the past three years? *
Do you currently use illegal drugs? *
After reviewing the job duties, can you do the job tasks required without special accommodations? *
Do you have a current Adult CPR certification card? *
Do you have a current First Aid certification card? *
What position(s) are you applying for? *

Education History #1


Education History #2


Education History #3


Employment History #1 (Current Employer)

May we contact? *

Employment History #2 (Previous Employer)

May we contact?

Employment History #3 (Previous Employer)

May we contact?


Reference 1
Reference 2
Reference 3

Professional Certification / License



I affirm and certify that all the information and answers to questions herein are complete, true and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for termination, whenever discovered. I authorize New Horizon Services to conduct any investigation it deems appropriate concerning my application. I hereby authorize and request former employers, personal references, schools, government agencies, health care providers, and all other persons and organizations to disclose credit, criminal record, employment and any other information that may be sought in connection with this application. I hereby release all of the above mentioned from all liability in connection with those disclosures. I further authorize the companies to disclose to others any information it may have concerning my employment, character, and qualifications, including information gained from this application and the investigation of this application. I herein release the companies from all liability in connection with those disclosures.
By signing herein, you are acknowledging that you have read and understand the terms of this release. *
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